Discourse on Sexuality- Beyond the Realms of Medicine

A take on homosexuality in India from the lens of a doctor and a media researcher… Where do we currently stand? June 26, 2015 brought a wave of happiness and relief for the millions of activists fighting for the gay rights all around the world. All countries, liberals as well as non-liberals, witnessed the historic judgement by US supreme court legalising the same-sex marriage in all states of America. This led us to remember the recent incident of the suicide by a young anaesthetist at India’s topmost medical institute- All India Institute of Medical Sciences (AIIMS), New Delhi; alleging her gay husband for forcing her to take this steep action, which had opened the Pandora’s Box on homosexuality yet again. We, as medicos, have had varied opinions on how to look at the differently oriented lot of our society. The public discourse around homosexuality has been divided between liberals and the conservatives. While, on one hand, gay rights activists have been aggressively advocating for the right to live with dignity, on the other hand, societal frameworks have painted a stifled reality in which couples (homosexuals and mixed orientation) and singles (homosexuals) are confined alike. The politics to biologically define homosexuality can be located within this tussle for what can be argued as a human right and need to set the human right.

While sociologists have argued for the need to understand gender and sexuality as a social construct, medical science has been making an attempt to understand it as a genetic or biological process. The ‘Gay gene’ however remains an unexplored mystery but it has set an unrivalled history that often resonates between the realms of legal, medical and religious frameworks of the society.

Beyond the Normative – Tracing the Legacy of ‘abnormality’

Indian society is famed for being less liberal compared to many western countries, especially when the issues concerning sexualities arise. After a ground-breaking judgement by High Court of Delhi legalising the consensual homosexual relationships, the Supreme Court of India in the Suresh Kumar Kaushal & Another vs Naz Foundation & Other case upheld the law against the same sex intercourse, the one that was brought into action almost 150 years ago under the British rule. The Law punishes “carnal intercourse against the order of nature with any man, woman or animal” with imprisonment up to life (1). Section 377 in Indian Penal Code was introduced by the British Empire in 1860 for ‘unnatural’ sexual offences. The Imperials in order to assert colonial control, without any cultural consultation with their subjects, imposed the law to inculcate European morality, which was governed by the Vatican’s dictum– ‘Sex is Sin’. Devdutt Pattanaik (author & mythologist) has argued that the sculptures across the temples of Indian mainland and Indian epics and chronicles including Mahabharata have references to same-sex intercourse, which cannot be dismissed as perverted fantasies of an artist (2). However, these acts were not part of the mainstream; their existence was acknowledged but not approved, though some amount of tolerance to heterosexuality was shown.

An etymological reading of the terms heterosexual and homosexual establishes the hierarchies being a social construct. Till early nineteenth century, the best of the medical texts and dictionaries continued to define heterosexuality as ‘Abnormal or perverted appetite toward the opposite sex’. It was only in the 1930s that heterosexuality attained the status of a norm (3). The abnormal has always been understood from a diabolical gaze setting it lower in the hierarchy.

Interplay of Hierarchies within the Institutional Structure

As the young doctor couple got tangled in these hierarchies of normality and abnormality, one needs to understand how these hierarchies work within an institutional framework. A ‘mixed orientation’ marriage is often interlaced between two kinds of social hierarchies- hetero/homo and men/women. It is this that further complicates the idea of ‘normative’. While the blame of the death of young anaesthetist held her gay husband accountable for an unconsummated marriage, her father-in-law defended the son by putting the onus of making the marriage work on the daughter-in-law. The patriarchal framework of the institution of marriage defines the responsibilities based on gender and expects the wife to be the caretaker, giver, sensible and responsible. The father-in-law, aware of his son’s alternate sexual orientations even before marriage, made sure to not give his son a relief from his mental confusions and social pressures built enough for the son to undergo a socially acceptable marriage. Yet again, when marriage, as an institution, fails to address the complexities of mixed sexual orientation, people often seek help from other social institutions like medicine and law. But, the question here is how the normative gets defined within these institutions?

A peep into the medical corridors

A nuanced analysis of the medical pedagogy highlights the existing lacunae in understanding homosexuality. A recent questionnaire based study conducted in Mumbai, India highlighted the inadequate understanding of homosexuality amongst the medical graduates and interns (4), a sensibility that is amiss in most doctors despite being trained in the premiere medical institutes. A medical professional deals with the impression of homosexuality being an illness that needs cure. Homosexuality is taught to be a sexual perversion and thereby people seeking counselling or medical assistance are generally ‘managed’ through psychiatric medications and psychotherapies to ‘treat the disorder’. The protocol of referring a confused adolescent seeking help, directly to a shrink makes the individual further confused, scared and often self-stigmatized. The resistance to being tagged as a psychotic-neurotic, being given psychotropic medications and fear of social ostracisation often leads to an individual being locked in one’s shell.

Over past 100 years, one can trace how the medical world has suggested various treatment options for this ‘pathology’, some of them being too brutal. Ranging from surgical approaches like castration and transplantation of testicular tissue from a heterosexual man, hypothalamotomies to hormonal manipulations making men more masculine, various approaches have failed(5). Psychiatry practices have treated homosexuals with antipsychotics and antidepressants besides classical conditioning by negative reinforcement and other such, at least mildly-inhuman, therapies. It is often the fear of this ‘abnormalcy’ defined within the medical paradigm that restricts individuals and couples to seek assistance from peers/ society to resolve conflicts around sexuality. It is the same that happened to the girl whose colleagues (all doctors) were oblivious of the challenges the couple faced in making their marriage work!

Aggressive advocacy and open public discourse in the west has seen an increasing resistance to the so-called reparative therapies. While American Psychiatric Association (APA) decategorized homosexuality as a mental illness in 1973, yet the social taboos persist and so continues the relentless urge to biologically define homosexuality. The status in India is not entirely conducive to support diverse sexual orientation. The psychologists, while dealing with homosexuals, often express lack of empathy, distaste or anger (5).

This interplay of hierarchies within various institutions further erodes the social fabric, which already marginalizes the homo-sexuals. It is in this context that one can understand why the couple could never consummate marriage neither separate. The stigma and the fear instilled by various social institutions including marriage and medicine, which they very much were part of, rarely provides scope to freely express and explore their sexuality, forcing them to curl in their own niche and accept the social norms of heterosexual marriages, which may not work out eventually.

The question is: Is this the trajectory that our understanding of sexuality needs to take?

Onus is on us, the medical practitioners, to sensitize ourselves and not condone discriminatory approach, while counselling people with diverse sexual orientation. The medical discourse needs to be geared towards not being resistant but supportive of multiple sexual identities, in order to strengthen the social fabric and not merely straighten it.

Saurabh is a surgeon who has completed his MS from AIIMS, a reputed medical school of India. One of the founders of Zigverve. Occasionally drumming for the band Alexithyme. Desires to help people keep themselves fit and healthy, and thus doing his bit in the direction through Zigverve.